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After CNA Training – Knowing What to Do

I mentioned in the first article of this series that I’ve been a Certified Nursing Assistant for a number of years. I also explained that although you may have taken your CNA training class at one of the best centers available, you’ll still come away from CNA training with a few gray areas. These are the things you’ll have to work out for yourself once you’ve been on the job. Now, your CNA training manual does cover ethics, how to effectively communicate with a patient, and other timely topics that deal with emotional issues. Your CNA training even covers the best way to deal with patient anger. I’m going to recount a particular situation that I faced as a home health aide. Now, you may or may not disagree with my tactics, but I assure you, they are completely ethical, and they worked for me in the long run. Here we go, things you don’t learn in CNA training 101!

After CNA Training: The Violent Patient

If you are in a home health situation, there are times you may run into a particularly irritated, angry, or even a violent patient. You may have learned from your CNA training instructor that patients who behave in ways which could cause bodily injury to themselves or others are often restrained. We’re talking about hospitals, adult care homes, and other medical facilities. But what about the in-home health aide situation? What do you do when you experience an escalating patient?

For a minute, let’s revert back to our CNA training. You probably remember these basic rules:

Never argue or provoke your patient to become angry

If you notice a patient escalating, either by an angry tone, angry speech, physical cues, or raised volume (yelling), you should remove yourself from the situation. Leave the room for a while unless you feel this will further provoke the patient, or if they would be in physical danger if you left the room.

Speak calmly. Use soothing tones and change the subject if possible.

If it will do no harm, try to agree with the patient. If you can’t agree, at least offer comfort, such as “I know how you feel.”

After CNA Training: My Experience With a Violent Patient

My particular patient was an elderly gentleman who was in a progressed state of Alzheimer’s Disease. He also had recently lost his wife. He regularly missed her and would become weepy and sad, but then forget why he was crying and become embarrassed. I had learned through my CNA training to recognize these patterns and had been able to deal with the situation without incident, until one Wednesday afternoon.

My patient began to call me by his wife’s name. I explained I was his nurse. He looked at me, confused. “Why would I need a nurse?” he asked. I explained that he needed some help with things around the house and he suddenly switched from confused to extremely angry. He proceeded to ask me what I had done with his wife and if I had harmed her. I calmly explained that I had not. He asked where she was and I responded that she had recently passed away. My CNA training had always taught me to be as truthful as possible. Wrong answer. My patient came toward me with all the energy of an 18 year old and began to strike me. I shielded my face, turned and ran the other way. I went into a bathroom and closed the door but did not leave the house. We learned in CNA training never to leave a dementia or Alzheimer’s patient alone.

My patient suddenly snapped back to reality. He had no recollection of striking me. When I returned from the bathroom, he was watching television and asked me for a snack. I never mentioned the incident. Now, according to my CNA training, I should have filled out an incident report, making my employer aware and notify the relatives in charge of his care. I did none of those things.

Why did I go against my CNA training? I feel that everything is a case by case basis. This patient was still grieving the loss of his wife, amid his frustration and his lack of lucid thought processes. I felt empathy for him.

Now, I don’t advise you to go against your CNA training and follow in my footsteps. I’m simply recounting a patient incident and how I dealt with it. Incidentally, I never had another violent issue with this patient again. If I would have, I would have reverted to my CNA training and reported the incident.

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